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Paul Richardson lives in Yarmouth.

There is a dangerous bait and switch happening in Washington right now that directly affects Maine, and our own Susan Collins is a major player in how it will affect all of us.

Supporters of the One Big Beautiful Bill Act have pointed to a $50 billion Rural Health Transformation Fund as proof that rural hospitals will be protected from the damage the legislation inflicts. But this claim can easily be debunked with just a little back-of-
the-napkin math.

The bill cuts approximately $1.02 trillion from Medicaid over the next decade, according to analysis from the Center for American Progress and the Kaiser Family Foundation. At the same time, because the legislation increases the federal deficit, it also triggers an estimated $490 billion to $500 billion in automatic Medicare cuts unless Congress acts to stop them.

That is roughly $1.5 trillion in combined healthcare reductions that kick in after our November election. Against that, lawmakers are offering $50 billion back to rural America, and these are the ads you’re seeing for Susan Collins daily on TV.

The $50 billion is a drop in the bucket compared to what they are taking. Think of it this way: if someone took $1,000 out of your pocket and handed you back $33, insisting you should be grateful because they “invested” in your future, you would recognize what it is, a true bait and switch.

And nowhere will that pain land harder than rural America in counties like Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Piscataquis, Somerset, Waldo and Washington counties.

Rural hospitals already operate on some of the thinnest margins in the country. Nearly 44% are already running negative margins, and more than 300 rural hospitals are considered at immediate risk of closure. Why? Because rural hospitals depend disproportionately on public payers due to a set sunk cost just to operate in a community where volume could never allow it to break even.

In many communities, Medicare and Medicaid account for 60% to 80% of total reimbursement. There is no large commercial insurance base to absorb the blow when federal support shrinks.

Here in Maine, we see the realities already. From Northern Light Health facilities in The County to critical access hospitals across Washington, Somerset, Piscataquis and Oxford counties, public reimbursement is the financial backbone that keeps emergency rooms open, labor and delivery units staffed and cancer care local.

When Medicaid coverage is stripped away through work requirements, more frequent eligibility checks and tighter financing rules, people do not stop getting sick; they just become uninsured. When uninsured patients still arrive at the emergency department, the hospital absorbs the cost.

That is how closures begin, but not all at once. First it is maternity care, then behavioral health, then dialysis, then oncology, then the hospital itself. And when a rural hospital closes, the loss ripples far beyond healthcare.

Hospitals are often among the largest employers in rural counties. Their collapse means lost jobs, weakened local economies, longer ambulance rides, delayed stroke care, higher maternal mortality and fewer reasons for young families or businesses to stay.

Maine has spent years debating how to preserve rural health access. Yet this federal legislation moves in the opposite direction by draining the very funding streams rural systems rely upon while offering back a fraction of what was taken and calling it a solution.

We should be honest about what this is. A trillion-dollar cut paired with a temporary $50 billion patch is not a rescue plan. This is an overt managed retreat. And for rural Maine, retreat is not an option, because as Maine goes, so goes the nation.